Impact of SARS-COV2 infection on the clinical outcomes in patients with lung cancer compared to all other cancers.
Authors: Vaishali Deenadayalan, Mona Dasgupta, Ali Shahbaz Baloch, Siri Chandana Swarna, Junglee Kim, Shweta Gupta
Journal: Journal of Clinical Oncology (2023)

8562 Background: The outbreak of 2019 Novel coronavirus disease (COVID) has led to various deleterious outcomes in cancer patients. Those with lung cancer were noted to have increased morbidity and mortality when infected with COVID. We aimed to study the outcomes of COVID infection in patients with lung cancer compared to those with all other types of cancer. Methods: Healthcare Cost and Utilization Project-Nationwide Inpatient Sample database-2020 was queried to identify all COVID patients with lung cancer and those with all other types of cancer excluding lung cancer. The groups were compared for socio-demographic differences, medical comorbidities, inpatient mortality, length of stay (LOS), and total hospital charges (THC). Secondary outcomes included a diagnosis of thrombocytopenia (TCP), Acute Respiratory Failure (ARF), sepsis, anemia, pancytopenia and shock. Statistics were performed using t-test, univariate and multinomial logistic regression. Results: A total 1,050,045 COVID-19 admissions in cancer patients were identified, of which 4,625 (8.7%) had lung cancer whereas 48,840 (91.3%) had other types of cancer other than lung cancer. Lung cancer patients were older (Mean age 72 vs 69 years, p &lt; 0.01). There was a higher prevalence of lung cancer compared to other cancers in whites (71 vs 58%, p &lt; 0.01), hispanics had a lesser prevalence of lung cancer (7 vs 17%, p &lt; 0.01). Lung cancer patients has a higher Charlson Comorbidity burden ( &gt; 2) compared to other cancers (91 vs 62%, p &lt; 0.01). Lung cancer patients were less likely to have private insurance (14 vs 22%, p &lt; 0.01). Among the comorbidity burden, lung cancer patients had a higher rate of dyslipidemia, COPD, Coronary artery disease, Smoking, venous thromboembolism (p &lt; 0.05). A total of 8,135 cancer patients who were admitted with COVID died, among them 970 (11.9%) had lung cancer and 7,165 (88.1%) had other types of cancer making up 21% of all lung cancer admissions that died compared to 14.7% other cancer admissions (p &lt; 0.05). On multivariate regression analysis, after adjusting for confounders those with lung cancer had a higher odds of all-cause mortality (aOR 1.37; 95% CI: 1.13-1.67,p = 0.002). Among lung cancer patients, adjusted LOS was reduced by 0.6 days (95% CI: -1.2 to -0.1, p = 0.017) and adjusted THC was decreased by $11,977 (95% CI: -19,010 to -4,943, p = 0.001). Among the secondary outcomes, lung cancer patients had lower rates of thrombocytopenia (6.5 vs 8.8%, p = 0.01) and anaemia (34.4 vs 38.5%, p = 0.02) compared to other cancer types. Conclusions: COVID-19 infection led to increased mortality in lung cancer patients compared to those with other types of cancer. The lower healthcare utilization was likely due to early mortality in the lung cancer cohort. This study calls attention to the increased vulnerability of lung cancer patients to the SARS COV2 infection than other cancer types.